Chronic kidney disease (CKD) is a major public health problem with as many as 20 million affected individuals in the US. Cardiovascular disease (CVD) is the primary cause of morbidity and mortality in CKD, and the presence of CKD is now recognized as an independent risk factor for development of CVD. The mechanism through which CKD increases CVD risk is however not well understood. Patients with CKD may be at increased risk for CVD because they may have an increased prevalence and severity of traditional risk factors, as defined by the Framingham population. Patients with CKD, are however, also exposed to a vast array of novel CVD factors, that increase in prevalence as kidney function declines (non traditional risk factors). There are few studies, however, that have evaluated the relative importance of traditional and non-traditional risk factors in patients with CKD. The Framingham coronary risk score uses a composite of traditional CVD risk factors to estimate the risk for incident coronary heart disease (CHD) in the general population. The risk score, has not however, been evaluated in prospective studies of patients with CKD. We propose to pool subjects with CKD, defined by an estimated glomerular filtration rate of 15 to 60 ml/min/1.73 m2, in two well-characterized cohorts: the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. This pooled CKD cohort is representative of the US population with CKD. Our general hypothesis is that the Framingham coronary risk score will not accurately predict CHD events in patients with CKD. Our specific aims are as follows. 1. To evaluate risk factors for CHD, cerebrovascular disease and all-cause mortality in 1678 subjects with CKD. 2. To compare the relative risk ascribed to each traditional risk factor in patients with CKD with that in the Framingham population, and to evaluate the discriminatory capacity and the calibration potential of the. Framingham coronary risk score to predict incident myocardial infarction (MI)/fatal CHD in 1105 subjects with CKD but without CVD. 3. To develop and evaluate a new prediction equation for Ml/fatal CHD in CKD utilizing both traditional and non-traditional factors. Achievement of the aims outlined is realistic. Statistical analyses reveal adequate power to evaluate each of the aims. Evaluating the importance of traditional and non-traditional risk factors in CKD is essential in that it will focus attention on the most important cardiac risk factors in this population. [unreadable] [unreadable] [unreadable]